Provider First Line Business Practice Location Address:
64 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17963-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-269-5532
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2007